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Why are we still waiting for midwifery legislation?

UPDATE: On Friday the NDP announced part of the healthcare component of its election platform, stating the party “will develop regulations under the Health Professionals Act to move midwifery forward so that women have more options for childbirth,” read a news release sent out to media.

With another provincial election season underway members of the midwifery community heave a sigh and collectively roll their eyes. Yet another provincial government has come and gone and the promise of midwifery legislation and infrastructure is still unrealized.

The consumer lobby group Friends of Midwifery was established in 1994 and has been lobbying ever since for the return of legislation. In that same year the Provincial Advisory Committee on the Status of Midwifery stated in its report that “midwifery is safe, cost-effective and a means of providing quality care for child-bearing women and their families in Newfoundland and Labrador.”

So why are we still waiting?

An integral part of our history and culture

Midwifery has been an important part of our province’s history and culture for many years. While our mothers may have birthed at The Grace Hospital, our grandmothers birthed with midwives in remote communities along the coast long before Joey’s centralization got under way. So prevalent was it at the turn of the last century, that 1920 saw the introduction of the Midwifery Act and the Grace Hospital in St. John’s began a midwifery training program four years later.

However, the ’60s saw an increase in the medicalization of birth after we became a Canadian province and following the introduction of the Hospital Insurance Act in 1958. The demand for midwives began to decline as hospital births were offered free. In 1963 the regulatory board ceased to give licenses and in 1986 the nurse midwife program at Memorial University was discontinued.

Historical significance and sentimentality aside, there are pragmatic reasons to support midwifery. In a health care culture that is increasingly medicalized and profit-driven, midwifery care provides the most cost effective model. Various studies in Canada show the cost savings to be between $800-$1,800 per birth with variations based on province and on whether the birth was at home or in the hospital.

And this cost-saving doesn’t come at the expense of better outcomes. When considering the low-risk, normal pregnancies that midwives are trained to support, the outcomes are comparable to those of obstetricians while the rate of interventions such as inducing birth, epidurals, episiotomies, and c-sections is significantly lower. Rates of pre-term birth are also lower in the midwifery-led model of care. Midwives are trained to support women to birth at home and when these women do birth in the hospital they have significantly shorter hospital stays. All this, along with higher reports of client satisfaction. Midwives provide better continuity of care, with a woman seeing the same midwife pre-natally, for the birth, and in the 6-weeks of follow up.

Why are we still waiting?

In Feb. 2014, following the release of a report it commissioned on midwifery in Newfoundland and Labrador, the provincial government committed to implementing regulations. This has not yet happened.

Midwifery is the model with the best costs, outcomes, and patient satisfaction for low-risk births with no known adverse effects. Yet Newfoundland and Labrador, despite its strong historical and cultural ties to the practice, remains one of only three jurisdictions in Canada without legislation and integration of the practice into the provincial health care system. Despite the demand being presented by consumer groups and midwifery professionals since the ’90s, and despite promises of legislation throughout the past decade, we are still the have-not province in terms of best practice and care for birthing mothers.

I applaud the work done thus far by the Midwifery Implementation Committee. Great strides are being made. My fingers are crossed and my breath is bated as I await the results of the years of hard work the committee members have invested. It is my hope that we achieve a true midwifery-led model of care as represented in the literature, since this is what provides the quality outcomes we see from midwifery care.

I look forward to hearing from our provincial candidates on their commitment to passing legislation regarding midwives in Newfoundland and Labrador during the next term.

In his party’s Nov. 9 platform announcement on health care, Liberal leader Dwight Ball said that “accounting for almost 40 cents of every dollar, [Newfoundland and Labrador has] some of the highest costs and some of the worst outcomes,” and that we “need to take a better approach to managing and delivering healthcare in our province.”

The news release claimed the “implementation of regulated midwifery has the potential to improve maternal health access and outcomes while optimizing the team of healthcare professionals,” a vague and slightly concerning statement given the ample evidence showing midwifery can be—and is being—done safely and effectively with midwives working independently.

While Progressive Conservative leader Paul Davis may believe that there are a “variety of views” on midwifery, the research remains unequivocal, regardless of political perspective. Meanwhile, during the Nov. 2 Status of Women Debate, NDP leader Earle McCurdy urged the expansion of midwifery in the province.

As the women of Newfoundland and Labrador well know, only time will tell if campaign rhetoric will lead to realized action or broken promises. The only way to support evidence-based maternity care for women as well as demonstrate fiscal responsibility is to move forward with midwifery legislation.

The women, children and families of our province deserve nothing less.

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